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Fundamentals of Clinical Research |
1
Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank
Rd., Milwaukee, WI 53226.
2
Department of Radiology, University of Washington, 325 Ninth Ave., Box 359728,
Seattle, WA 98104.
3
Diagnostic Radiology and Nuclear Medicine, University of Western Ontario,
London Health Sciences Center, University Campus, 339 Windermere Rd., London,
Ontario N6A 5A5, Canada.
4
Department of Radiology, Montreal General Hospital, 1650 Cedar Ave., Montreal
P. Q. H3G 1A4, Canada.
Received July 14, 2000;
accepted after revision July 14, 2000.
Series editors: Craig A. Beam, C. Craig Blackmore, Steven Karlik, and
Caroline Reinhold.
Introduction
 Top Introduction The Value of Research...Goals and OverviewDiscussionReferences |
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Research is the "eccentric uncle" of radiology. The specialty acknowledges "his" presence, brings "him" out at appropriate times to be viewed and admired, and, when the mood strikes, pays homage to "his" importance. However, the specialty has always treated research at arm's length, outside the greater, clinical concerns of organized radiology [1].
The preceding telling quote was uttered by Charles Putman and comes from a special article reporting the findings of the 1991 Radiology Summit Meeting [1]. This meeting, one in a series of annual events sponsored by the Intersociety Commission of the American College of Radiology (ACR), was held in Asheville, NC. For this meeting, radiology leaders from the United States and Canada were invited to discuss the issue of how to improve the research performed by radiologists. Obviously, the point of the quotation is that leaders in radiology think it is time to assign research a role greater than that of just the too often ignored and impotent relative.
The group reached the consensus that research has important intrinsic values both to the specialty and to individual radiologists and made the following recommendation [1]:
To improve understanding of the value and methods of research, all trainees and faculty should receive basic instruction in critically reading the medical literature, experimental design, and biostatistics. Those wishing to conduct research should receive more extensive training.
The Value of Research to Radiology
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TopIntroductionThe Value of Research...Goals and OverviewDiscussionReferences |
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From a more pedestrian perspective, research can be seen as a means to protect and expand "turf." As an example, consider the fact that research by radiologists in minimally invasive therapies, and development of these techniques, has allowed radiologists to assume a dominant role in this area. However, many believe that this area of interventional radiology is currently at risk of being swallowed by the surgical specialties. Active research and continued leadership in innovation and technology improvement by members of our specialty will help radiology maintain a primary role and prevent the attrition of the many areas of radiology practice.
Finally, from a loftier perspective, research is essential for practicing good medicine. We all have anecdotes about how cautious we must be in drawing conclusions from limited and subjective experience. For example, because we have diagnosed a case of pericardial tamponade from CT findings does not mean that CT is the imaging modality of choice for this condition, or that all patients at risk for pericardial tamponade should undergo CT. Good medicine requires decision making based on evidence, and research is the method by which this evidence is acquired, synthesized, and put into action. Sometimes this pattern of research is codified into practice guidelines and disseminated for the benefit of other practitioners. Greater effort in conducting the research for developing practice guidelines in radiology is needed.
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TopIntroductionThe Value of Research...Goals and OverviewDiscussionReferences |
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To meet this goal, the coeditors of the series designed 22 articles with associated software that form modules of self-instruction. Each journal article and its associated software are intended to be complementary, not repetitive, learning experiences. The software, which will be available on the ACR Web site, will help readers better understand, evaluate, and refine their mastery of the material, as well as allow them to practice what has been learned. As outlined in the Appendix, it is our plan to offer an initial series of six modules at a basic level, eight modules at an intermediate level, and eight advanced-level modules.
The editors are sensitive to the ease with which methodology articles can become user-unfriendly when discussing statistical aspects of research. To ensure that modules are applicable to all readers, articles about statistical methods will show relevance to clinical radiology research by providing examples of the methods from the radiology literature within the past 10 years. These articles will accentuate concepts, definitions, and rules for use. Pictures and diagrams will be encouraged. Formulas will be discouraged and, if absolutely necessary, will be limited to an appendix.
The goal for the more advanced statistical articles is to give readers a basic understanding of the research methods available and to evaluate their appropriateness when used in the literature. This will allow readers to critically review the statistical methods section of an article or proposal and the resultant interpretation of results. This is a critical skill, not only for the researcher but also for the clinical radiologist, who must continuously reassess his or her daily practice on the basis of new information available in the literature. Another goal is to provide the reader with a sufficient base with which to conduct independent radiology research. However, these modules are not designed to replace formal training in epidemiology and biostatistics. It is our goal that these modules provide enough background so that radiologists know when to seek statistical expertise and to facilitate communication with experts in methodology.
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TopIntroductionThe Value of Research...Goals and OverviewDiscussionReferences |
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Training residents, fellows, and junior faculty in facets of research and critical inquiry by radiology departments in both the United States and Canada is recognized by leaders of our specialty to be a critical need. However, exposure to the discipline of research has been sporadic in distribution and nonuniform in content. The recent evaluation of the introduction to research program for second-year residents by the Radiological Society of North America, Association of University Radiologists, and American Roentgen Ray Society indicated that such a program encourages development of research careers in those individuals who are oriented to research independently of participating in the training program [2].
Although there is considerable background information available for teaching aspects of critical inquiry, these materials are tailored to the academic disciplines from which they arise and are sometimes too esoteric for the specific needs of radiologists and radiology residents. What is needed is a thorough introduction to the topics with radiology-specific examples cast in a professor- and student-friendly manner.
Stolberg et al. [3] have recently detailed aspects of a core curriculum in the evaluative sciences for diagnostic imaging. The list of desirable areas of interest include clinical epidemiology, scientific method and study design, evaluation of diagnostic tests and screening, biostatistics and health economics, and technology assessment. One of the significant issues they identified was the mechanism to teach the evaluative sciences to radiology residents. Specifically, their discussion focused on problem-based or lecture-based alternatives, with an argument being made that some combination of the two would likely be optimal, depending on the individual program. Our ACR-CAR program will be a resource for all radiology residency programs that could be presented by local experts. The software will provide an interactive, problem-based adjunct to this presentation.
Our goal is to commission 22 modules. This is a prodigious list of concepts that most practicing radiologists in the United States and Canada have likely not had the opportunity to study. These topics remain significant by their absence in many radiology training programs today. Without an appreciation of these issues and their vital role in producing research excellence, radiology publications will continue in their time-honored and out-of-date series descriptions.
However, the materials we are proposing in this series can be considered only as expert resources. They will give specific and comprehensive information at the junior level to form a basis for the teaching of the critical inquiry to radiology residents, fellows, and junior faculty. The materials are meant to support, not replace, institutional instruction in these disciplines. With such materials easily available throughout the radiology community, it will become a far easier task to ensure exposure of radiologists and residents to these very important topics.
These efforts are not meant to dilute any of the essential aspects of the radiology training program. On the contrary, this series will provide a specific, highly concentrated, and relevant primer in critical inquiry. It is time that radiology incorporates these effective and scientific aspects into the discipline. Otherwise, our research efforts might come to be regarded as the "eccentric uncle" of medicine.
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  A. R. Schleipman Navigating the Biomedical Research System as a Full Participant: Strategies and Opportunities for the Nuclear Medicine Technologist J. Nucl. Med. Technol., September 1, 2007; 35(3): 170 - 175. [Full Text] [PDF]
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 R. C. Brunken, D. R. Neumann, B. Bybel, C. C. Blackmore, and C. A. Beam Beyond Radiology Consultant Am. J. Roentgenol., November 1, 2001; 177(5): 1216 - 1217. [Full Text] [PDF]
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C. C. Blackmore The Challenge of Clinical Radiology Research Am. J. Roentgenol., February 1, 2001; 176(2): 327 - 331. [Full Text] [PDF]
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